Quebec pushes the boundaries on assisted dying once again

During 10 years as a member of Quebec's National Assembly, François Bonnardel developed a reputation as a tireless fighter for fiscal rectitude. But it took an emotional plea on behalf of his Alzheimer's-afflicted mother for this opposition MNA to really get the government's attention.

In February, Mr. Bonnardel, a 49-year-old member of the right-leaning Coalition Avenir Québec, touched the hearts of an entire province when he came close to breaking down during a news conference to call for a review of Quebec's law on medical aid in dying. The current law, he said, left him feeling helpless as he watched his 80-year-old mother's horrible decline unfold.

"I saw her go downhill, cease to recognize me, cease to smile, cease to speak, cease to appreciate life and become a prisoner in her own body. … I would be ready today as a son for my mother to, well, it's difficult for me to say," he confided, too overcome with emotion to complete his sentence, but leaving no doubt in anyone's mind about how to fill in the blanks.

Quebec forged the way in Canada on medical aid in dying (MAID), legalizing the practice even before the Supreme Court struck down the Criminal Code ban on assisted suicide. Now, the province is set to push the boundaries once again, moved in part by Mr. Bonnardel's cri du coeur and the case of a distraught husband charged with second-degree murder in the death of his Alzheimer's-stricken wife.

On March 24, Health Minister Gaétan Barrette announced a three-pronged approach aimed at potentially broadening the eligibility requirements for medical aid in dying. First, a provincial commission will examine the more than 250 requests for the procedure that have been either rejected or withdrawn since the practice was legalized. A group of experts will subsequently re-examine the question of allowing advance consent for MAID by people diagnosed with degenerative diseases such as Alzheimer's and other forms of dementia. Quebec's Justice Ministry, meanwhile, will ask the courts to clarify the federal MAID law's limit of the practice to only those facing a "reasonably foreseeable" death, which health professionals have complained is too vague.

We all know where this is heading. Sooner or later, it seems inevitable that Canada will find itself obliged to allow those with degenerative diseases to sign advance directives authorizing doctors to end their lives once they become incapacitated. Provincial and federal committees struck in recent years have recommended it and MAID advocacy groups continue to demand it. Media coverage of desperate wives, husbands, sons and daughters seeking a "dignified" death for loved ones suffering from dementia will keep the heat on politicians to act. As will the sheer explosion in the number of Alzheimer's cases we are told to expect in coming years.

None of this will make the path we have embarked on any less fraught with ethical red flags than it should be. There can be nothing ethically clear-cut about deciding when to end the life of an Alzheimer's sufferer who is no longer cogent enough to consent. The whole notion of "unbearable suffering" (one of the federal law requirements for MAID) is in itself inscrutable when it comes to Alzheimer's and dementia. Unbearable for whom? Just whose suffering is being alleviated when loved ones ask God or the state for their dementia-stricken ward to die?

For what it's worth, the Alzheimer Society of Canada argues that "MAID should only be possible when a person is deemed competent at the time of MAID. … [P]eople with dementia need to be safeguarded as they will be extremely vulnerable at the end of their life [and] do not have the capacity to make an informed decision and consent to end their life at the later stages of the disease."

Personally, that's enough guidance for me. But I understand how Mr. Bonnardel feels.

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These are among life's biggest questions, so far be it from me to preach. But we have to be honest about the process we've embarked on. There is nothing "rational" about an issue that defies neat or clinical definitions and goes to the very heart of the meaning of life. While it involves an eminently personal choice, it's incumbent on society to protect the vulnerable by repudiating any suggestion that those with Alzheimer's have "lost their dignity" or "become a burden." It's a slippery slope.

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